Ligation clip applier and method

ABSTRACT

A torsional ligation clip applier and method of use for endoscopic or laparoscopic vessel occlusion procedures is provided. The ligation clip includes a hub portion and ligation arms for occluding a vessel. Ligation arms are independently rotatable about a common axis that is parallel to the longitudinal axis of the ligation arms. The ligation arms are biased in a first position by a biasing mechanism. The ligation arms of the clip are rotatable through at least one of a plurality of positions wherein it has a larger diameter than an access device. An applier receives at least one ligating clip in a first position and delivers the ligating clip to a vessel in a second position. Occlusion of the vessel occurs when one of the ligation arms is rotated into a third position.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority from, and the benefits of, U.S.provisional application No. 60/376,424 filed on Apr. 29, 2002, theentire contents of which are incorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to ligating clips, and to devices andmethods for applying the same in surgical procedures. More specifically,the present disclosure relates to torsionally biased surgical ligatingclips suitable for clamping blood vessels and ducts during laparoscopicor endoscopic surgery.

2. Background of Related Art

During surgical procedures, procedures frequently require the temporaryor permanent occlusion of vessels to prevent the leakage of fluids (e.g.blood) through incisions made at the surgical site. A broad range ofsurgical ligating devices and techniques exist for occluding vessels.These include applying surgical ligating clips that are available in avariety of shapes and sizes including spring biased wires and plates.Typically, these devices are stored in a first position wherein the jawsof the clip are biased closed. The applying device opens the jaws of theligating clip a predetermined distance against the bias of the ligatingclip to position the ligating clip about a vessel. The applying devicethen releases the jaws to allow the bias of the ligating clip to returnthe jaws of the ligating clip to the closed position and occlude thevessel.

Ligating clips configured for use with applying devices are frequentlylimited in their application by the distance the jaws can open withoutpermanently deforming the clip. The use of such clips is further limitedby the accessibility to the surgical site. For example, only those clipssized to be inserted through an appropriately sized cannula can be usedduring laparoscopic or endoscopic procedures. In addition, clips havingextended jaws can lose the amount of applied bias over time as thetissue shrinks and/or necroses.

Ligating clips for clamping blood vessels and ducts during open andendoscopic (herein understood to include laparoscopic) surgicalprocedures are well known in the art. The particular dimensions of aligating clip to be used in an open surgical procedure are notconstrained by the size of the access opening to the surgical site.However, during endoscopic surgical procedures access to the surgicalsite is typically achieved through an access device, such as a cannula,having a limited internal dimension (e.g. a diameter of 15, 10, or 5mm). Accordingly, ligating clips used during endoscopic surgicalprocedures must be dimensioned and configured to be admitted to thesurgical site through the access device. Because of the dimensionalconstraints on ligating clips used for endoscopic surgery, currentlyavailable ligating clips suffer from several drawbacks. These drawbacksinclude a smaller or reduced clamp opening, i.e., the distance betweenopposed clamping members of the ligating clip in the open position, anda difficulty in applying the ligating clips about tissue.

A continuing need exists for a simplified ligating clip having suitableflexibility for application over a range of vessel sizes withoutexcessively deforming and that can maintain pressure on a vessel evenwhen the vessel increases or decreases in size over time.

A continuing need also exists for a ligating clip that can be of a sizethat facilitates delivery through a cannula of limited internaldimensions, yet can maintain pressure on a vessel even when the vesselincreases or decreases in diameter over time.

Accordingly, a need exists for a ligating clip that is suitable for useduring endoscopic surgical procedures that has an enlarged clamp openingthat can be positioned quickly and easily about tissue. In addition,there is a need for a ligating clip system including an applier andmethod for applying the ligating clip.

There is also a need for a clip applier that can apply theaforementioned ligating clips and that can be employed through cannulaehaving internal diameters of 15, 10, or 5 mm.

SUMMARY

This invention is directed to a ligating clip for occluding a vesselincluding first and second clamping members. Each of the clampingmembers includes a hub portion with a substantially centrally locatedthroughhole where the hub portions defining a common pivot axis for thehub portions and clamping members, an elongated ligation arm disposedsubstantially parallel to the common pivot axis, and a hub extensionextending between and connecting the hub portion to the ligation arm,the first and second clamping members being pivotably connected by abiasing member such that the clamping members are rotatable about thecommon pivot axis, and the ligation arms are biased by the biasingmember. Each ligation arm can include an elongate vessel clampingsurface where the clamping surfaces are biased by the biasing member toengage each other to clamp a vessel therebetween. The biasing member canbias the ligation arms such that in the absence of a vesseltherebetween, the clamping surface of one ligation arm contacts at leasta portion of the other ligation arm's clamping surface. One of the firstand second clamping members can be rotatable relative to the otherclamping member through an arc of from about 0° to about 360°, or, lesspreferably, through an arc of from greater than about 0° to about 360°.Each ligation arm can include a ligation arm abutment surface that isoppositely disposed to each ligation arm's clamping surface and theabutment surfaces of the ligation arms being abuttable with each other.The biasing member can bias the ligation arms such that the ligationarms are rotatable from and amongst a plurality of positions. Thebiasing member may be a torsion spring. Each ligation arm can bedisposed substantially orthogonal to the hub extension to which theligation arm is connected. One clamping member can have an extensionabutment surface that is adapted to abut the hub extension of theopposed clamping member. The throughhole of one hub portion can bedefined by the inside surface of a cylindrical wall that defines thecommon pivot axis, and the outside surface of the cylindrical wallpartly defines a portion of a channel for receiving the biasing membertherein.

This invention is also directed to a ligating clip system for occludinga vessel including at least one ligating clip having first and secondclamping members. Each of the clamping member includes a hub portionwith a substantially central throughhole where the hub portions define acommon pivot axis, a ligation arm disposed substantially parallel to thecommon pivot axis, and a hub extension connecting the hub portion to theligation arm, where the first and second clamping members are pivotablyconnected such that each is rotatable about the common pivot axis inrelation to the other and the ligation arms are biased by a biasingmember, and an applier including an elongate tube having a diameter, theelongate tube having a proximal end and a distal end defining a channeltherebetween, the channel configured and adapted to receive and restrainthe at least one ligating clip, the channel further including anelongate pusher member disposed along a longitudinal axis of the tube,the pusher member being for advancing the ligating clip a predetermineddistance distally along the longitudinal axis. The clamping members ofthe ligation clip can be biased for rotation amongst a plurality ofpositions. Each ligation arm can include a clamping surface and anopposed abutment surface. The biasing member may be a torsion spring.The system can include an actuation mechanism where the actuationmechanism includes a trigger assembly. The channel can receive andrestrain the at least one ligating clip in a first position where theabutment surfaces are in contact with one another. The distal end of thetube can be adapted and configured to contact the clamping assemblies.The biasing member and the distal end of the tube can cooperate torotate the clamping members of the ligating clip from the first positionto a second position as it advances distally from the distal end of thechannel wherein the first ligation arm is spaced apart from the secondligation arm. The first and second ligation arms can be substantiallyparallel to one another in a substantially planar arrangement. Theligation arms can span a distance that is greater than the diameter ofthe distal end of the elongate tube. The biasing member and the distalend of the tube can cooperate to rotate the clamping members of theligating clip from the second position to a third position as theligating clip advances from the channel to the predetermined distancewherein the clamping surfaces are biased by the biasing member to engageone another in a manner sufficient to occlude a vessel therebetween wereit placed between the clamping members. The elongate tube can haveopposed first and second inserts disposed along at least a portion ofthe elongate tube where the inserts restrain the ligating clip in thefirst position inside the elongate tube. The elongate tube can includeopposed elongate restraining walls running through at least the distalend of the tube where the opposed restraining walls forming a cliprestraining channel, and one of the restraining walls forming a ledgethat extends distally from and beyond the distal end of the tube.

This invention is further directed to a method for occluding a vesselincluding the steps of making an incision in a patient, inserting anaccess device into the incision, inserting a clip applier into theaccess device where the applier has a distal end and at least oneligating clip, and the at least one ligating clip has a pair of distallyextending ligation arms biased to clampingly engage each other and theclip being in a first position of a plurality of positions, actuating anactuation mechanism located on or in the applier to cause the ligationarms of the ligating clip to rotate to a second position of theplurality of positions where the ligating arms in the second clipposition being of a span greater than a diameter of the clip applier,positioning the ligating clip around the vessel, and actuating theactuation mechanism located on the applier to cause the ligating clip tobiasedly rotate to a third position of the plurality of positionsthereby clampingly engaging and occluding the vessel. The ligating clipin the second position can have a larger outside diameter than theaccess device. The applier can include a number of ligating clips. Theaccess device can be a cannula. The actuation mechanism can be a triggerassembly. The applier can include opposed first and second insertsdisposed along at least a portion of the inside of the elongate tubewhere at least one of the inserts extending beyond the distal end of theapplier and restraining the ligating clip in the second position.

This invention is directed to a clip applier including an elongatetubular member having proximal and distal ends, opposed elongaterestraining walls running through at least the distal end of the tubularmember where the opposed restraining walls forming a clip restrainingchannel, and an elongated pusher for pushing a clip through and beyondthe distal end of the tubular member. One of the opposed restrainingwalls can form a ledge that extends distally from and beyond the distalend of the tubular member and the elongated pusher is adapted to pushthe clip onto the ledge.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the presently disclosed ligating clip aredescribed herein with reference to the drawings, wherein:

FIG. I is a perspective view of an embodiment of a ligating clip in afirst position in accordance with the present disclosure;

FIG. 2 is a perspective view of the ligating clip of FIG. 1 in a secondposition;

FIG. 3 is a perspective view of the ligating clip of FIG. 1 in a thirdposition;

FIG. 4A is a proximal end view of a first clamping member of theligating clip of FIG. 1;

FIG. 4B is a distal end view of a second clamping member of the ligatingclip of FIG. 1;

FIG. 4C is a proximal end view of the second clamping member of theligating clip of FIG. 1;

FIG. 5A is a perspective view of the first clamping member of theligating clip of FIG. 1;

FIG. 5B is a perspective view of the second clamping member of theligating clip of FIG. 1;

FIG. 5C is a proximal end view of the ligating clip of FIG. 1 in thefirst position;

FIG. 6A is a side view of the first clamping member of the ligating clipof FIG. 1;

FIG. 6B is a side view of the second clamping member of the ligatingclip of FIG. 1;

FIG. 7 is a perspective view, with parts broken away, of an embodimentof an applier having a ligating clip in the first position in accordancewith the present disclosure;

FIG. 8 is a perspective view, with parts broken away, of the applier andligating clip of FIG. 4 in the second position;

FIG. 9 is a perspective view, with parts broken away, of the applier andligating clip of FIG. 4 in the third position;

FIG. 10 is a perspective view, with parts broken away, of the applierand ligating clip in the second position surrounding a vessel; and

FIG. 11 is a perspective view, with parts broken away, of the applierand ligating clip in the third position with the vessel captured, oroccluded, by the clip.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Preferred embodiments of the presently disclosed ligating clip will nowbe described in detail with reference to the drawings, in which likereference numerals designate identical or corresponding elements in eachof the several views. As used herein, the term “distal” refers to thatportion of the tool, or component thereof which is further from the userwhile the term “proximal” refers to that portion of the tool orcomponent thereof which is closer to the user.

Referring to FIGS. 1-3, the surgical, or ligating, clip, shown generallyas 10, includes first and second clamping members 12, 14. Clampingmembers 12, 14 include hub portions 16, 18, respectively, hub extensions20, 22, respectively, and ligation arms 24, 26, respectively. Hubportions 16, 18 are stacked one on top of the other and are pivotal onein relation to the other about a common central pivot axis-W (FIG. 2).Each hub portion 16, 18 has a substantially central throughhole 30. Whenhub portions 16, 18 are stacked on top of one another, throughholes 30are aligned with each other and define common central pivot axis-W. Hubextensions 20, 22 project generally radially and outwardly from hubportions 16, 18 and join ligation arms 24, 26 substantiallyperpendicularly to hub extensions 20, 22 and substantially parallel to,but offset from each other when hub extensions 20, 22 are seen in endviews (see FIG. 5C).

Hub portions 16, 18 include channel portions 27 a, 27 b, respectively,for engaging one end of a biasing member 28. In combination, such aswhen hub portions 16, 18 are aligned and stacked one on top of the otheror behind the other, as shown in FIG. 5C, channel portions 27 a, 27 bform the terminal end portions of a channel 27 that is configured anddimensioned to receive biasing member 28, preferably a torsion spring(not shown). Each channel portion 27 a, 27 b may include a shoulder or arecess formed within each hub portion 16, 18 to receive or restrain theterminal ends of biasing member 28. Biasing member 28 is positioned forrotating clamping members 12, 14 in relation to each other about pivotaxis-W. Preferably, one of clamping members 12, 14 is independentlyrotatable in relation to the other over an arc of from about 0°, lesspreferably from greater than about 0°, to about 360° (less than 360°,because of the width of one ligation arm). Alternately, other channelportions are envisioned, for example, a groove for receiving at least aportion of the terminal end of biasing member 28, or a hole forreceiving the terminal end of biasing member 28.

Each ligation arm 24, 26 has an abutment surface 24 a, 26 a and aclamping surface 24 b, 26 b, respectively. Preferably, the thickness ofeach ligation arm 24, 26 decreases from its abutment surface side 24 a,26 a to the clamping surface side 24 b, 26 b. Alternately, ligation arms24, 26 may have other configurations, e.g., circular, oval, oblong,triangular, rectilinear, etc. In the first, or fully open, startingposition of ligating clip 10, i.e., when clamping members 12, 14 havebeen rotated against the bias of biasing member 28 into contact witheach other, abutment surfaces 24 a, 26 a abut against one another alongligation arms 24, 26, as shown in FIG. 1.

Ligating clip 10 is shown in a second, or “ready,” position in FIG. 2.With clamping member 12 held steady or restrained and clamping member 14unrestrained, as in FIG. 1, biasing member 28 moves clamping member 14in a clockwise arc of 180° towards clamping member 12 causing rotationof clamping member 14 about central pivot axis-W. By way of example,which is not shown, if clamping member 14 is restrained and clampingmember 12 is unrestrained, biasing member 28 will move clamping member12 counterclockwise toward clamping member 14. Referring again to FIG.2, applied force from biasing member 28 causes clamping member 14 torotate about central pivot axis-W. In a preferred embodiment, in theintermediate, ready position, ligation arms 24, 26 are shown about 180°apart and substantially parallel to one another. FIG. 2 shows ligationarm 26-in transit to the approximate 360° position, restrained at the180° position. It is contemplated that a ligation arm can be restrainedat any rotational position, 180° being preferred because it provides thewidest spread of the ligation arms to facilitate placing a vesseltherebetween.

FIG. 3 shows ligating clip 10 in the third, or fully closed, ligating,or clamped position, where clamping surfaces 24 b, 26 b abut againsteach other. Clamping surfaces 24 b, 26 b may be provided with anirregular surface, e.g. roughened, patterned, knurled, undulated,protrusions, etc., to enhance gripping and/or clamping of tissue.Biasing member 28 maintains clamping surfaces 24 b, 26 b in the abuttingrelationship shown in FIG. 3.

By rotating clamping members 12, 14 about pivot axis-W and against thebias of biasing member 28 until abutment surfaces 24 a, 26 a are incontact with one another, ligating clip 10 will be back in the first, orfully open, position (see FIG. 1). If clamping members 12, 14 arereleased simultaneously (i.e. neither clamping member 12, 14 isrestrained), biasing member 28 imparts rotational force to each clampingmember 12, 14 that will cause clamping members 12, 14 to initiallyrotate away from each other about pivot axis-W. Since neither member isbeing restrained, clamping members 12, 14 will both rotate through thesecond, or ready, position (see FIG. 2) where they are about 180° apartand substantially parallel to one another. Biasing member 28 continuesto apply biasing forces that cause the continued rotation of clampingmembers 12, 14 about pivot axis-W until clamping surfaces 24 b, 26 b arein contact with one another, thereby defining the third, or clamped,position of ligating clip 10 (see FIG. 3).

Ligating clip 10 is preferably formed from surgical grade plastics,although the biasing member may be formed from a surgical grade metal.Alternately, the ligating clip may be formed from any material suitablefor surgical use including metals, plastics, ceramics, etc. Ligatingclips can be comprised of biodegradable or biological material.

Detailed views of the components of ligating clip 10 are illustrated inFIGS. 4A-4C. First, with reference to FIG. 4A, a proximal end view ofligating clip 10 is shown, detailing the structure of first clampingmember 14. As previously discussed, clamping member 14 includes hubportion 16 having a cylindrical wall 32 defining throughhole 30 that iscentrally disposed in hub portion 16 and whose central axis is alignedwith central pivot axis-W. Hub portion 16 includes a peripheral wall 33that surrounds cylindrical wall 32. The two walls together generallydefining an annular channel 27 (dashed lines in FIG. 1) having atangential terminal end portions including channel portion 27a (dashedlines in FIG. 1) in hub portion 16 of first clamping member 14 andchannel portion 27 b (dashed lines in FIG. 1) in hub portion 18 ofsecond clamping member 12. Abutment surface 26 a and clamping surface 26b are on opposing sides of first clamping member 14, while ligation arm26 is connected to hub extension 20 in an orthogonal arrangement.

FIG. 4B shows a distal end view and FIG. 4C shows a proximal end view ofsecond clamping member 12. Second clamping member 12 includes hubportion 18 that has a circular configuration, thereby defining largethroughhole 30 that receives cylindrical wall 32 of first clampingmember 14. A channel portion 27 b is in communication with throughhole30 and extends, preferably as a tangential groove or slot, internal tohub extension 22. Abutment surface 24 a and clamping surface 24 b are onopposing sides of second clamping member 12, while ligation arm 24 isconnected to hub extension 22 in an orthogonal arrangement. FIG. 4Bshows an angled or diagonal abutment wall 25 adjoining ligation arm 24and hub extension 22 for abutting hub extension 20 of clamping member14.

FIGS. 5A and 5B show perspective views of first clamping member 14 andsecond clamping member 12. In FIG. 5A, first clamping member 14 includeshub portion 16. Disposed in hub portion 16 is cylindrical wall 32 thatextends beyond the plane of hub portion 16. Cylindrical wall 32 isdisposed in the center of hub portion 16, defines throughhole 30, and isadapted for sliding engagement or coupling with hub portion 18 of secondclamping member 12. Clamping member 12, as shown in FIG. 5B, includeshub portion 18 that defines throughhole 30 and that is configured anddimensioned for peripherally encompassing cylindrical wall 32 ofclamping member 14. Hub extensions 20, 22 are connected to hub portions16, 18 respectively and extend preferably generally radially outwardfrom hub portions 16, 18, and substantially parallel to the planedefined by the distal surfaces of respective hub portions 16, 18.Ligation arms 24, 26 extend perpendicularly and distally from the distalwalls of hub extensions 20, 22. Abutment surfaces 24 a, 26 a are adaptedfor contact with each other along at least a portion of, preferablytheir entire length.

FIG. 5C shows a proximal end view of the assembled clamping members 12,14, in the first, or closed, position. The proximal and distal faces ofhub portions 16, 18 are preferably parallel to the proximal and distalfaces of hub extensions 20, 22. Ligation arms 24, 26 communicateorthogonally with hub extensions 20, 22 and are disposed generallyparallel to pivot axis-W. Peripheral wall 33 of hub portion 16 surroundscylindrical wall 32 to form a portion channel 27 in hub portion 16.Peripheral wall 35 of hub portion 18 has the same diameter and thicknessas peripheral wall 33 of hub portion 16, and together the hubs formchannel 27 for biasing member 28 (not shown). Clamping surfaces 24 b, 26b are disposed on the outer edges of ligation arms 24, 26 (see alsoFIGS. 6A and 6B).

FIGS. 7-9 show a ligating clip system, i.e. a clip applier and clip,where ligating clip 10 is being applied to a surgical site using anapplier 50 having a longitudinal axis-X and preferably a cylindricalbody 52 having a pair of spaced inserts 54 a, 54 b. Inserts 54 a, 54 bcan be generally semi-spherical but, as shown, preferably are arcuatesegments of a circle (i.e. formed by a secant). The internal wall ofcylindrical body 52 and the secants of inserts 54 a, 54 b define achannel 56 having flat walls 58 and spherical walls 60. Insert 54aprojects, preferably permanently, outwardly from the distal end 52 a ofcylindrical body 52. Alternately, other channel configurations, orstops, that provide a stop against rotation of hub extensions 20, 22 andthereby prevent relative rotation of arms 24, 26 while ligating clip 10is positioned within channel 56 are envisioned.

A pusher member 100, shown schematically (in dashed lines) in FIG. 7, ismovably positioned within cylindrical body 52. At least one, andpreferably multiple, ligating clips 10 (one shown) are positioned inlongitudinal alignment within channel 56 of cylindrical body 52preferably in the first, or fully open, position (FIG. 1) with ligationarms 24, 26 positioned distally of hub portions 16, 18. The distal endof the pusher member 100 is positioned to engage a proximal end portionof ligating clip 10, e.g., the proximal face of hub extension 22 of theproximal-most ligating clip 10. Other engagement, clip ejection, and/orpusher systems know in the art can be employed herein for pushing aproximal clip to eject and apply a distal-most clip.

The proximal end of cylindrical body 52 can be attached directly to,near, or to a remote housing (not shown). An actuation mechanism can beincluded in the housing and can be operatively coupled to pusher member100. The actuation mechanism is adapted and configured to distallyadvance pusher member 100 a predetermined distance for each actuationoperation and consequently to distally advance ligating clip 10 thepredetermined distance.

Preferably, one complete operation of the actuation mechanism willresult in the distal advancement of ligating clip 10 such that hubextension 20 engages or goes beyond the distal end of insert 54 a andwill result in the occlusion of vessel 90. In order to ensure that onlyone ligating clip 10 is expelled during one operation of the actuationmechanism, preferably a latch and pawl mechanism (not shown) is providedin the housing. In operation, as the actuation mechanism is operated,pusher member 100 is moved distally through cylindrical body 52 therebyengaging and commencing the advancement of ligating clip 10. Once theactuation mechanism is engaged for operation, the latch and pawlmechanism is configured to prohibit the actuation mechanism frombackstroking until the actuation mechanism has been completely cycledand ligating clip 10 has been fully advanced, thereby expelling it fromcylindrical body 52. Upon complete operation of the actuation mechanism,the pawl clears the gear teeth (not shown) and the pawl rotates awayfrom the teeth due to a spring biasing (not shown), thereby allowing theactuation mechanism to return to its ready condition.

Upon complete operation of the actuation mechanism, pusher member 100travels a predetermined distance through cylindrical body 52, causingligating clip 10 to be advanced a predetermined amount. Preferably, thedistance is sufficient for ligating clip 10 to engage and occlude vessel90, and to distally advance at least one additional ligating clip 10such that at least a portion of ligation arms 24, 26 are exposed atdistal end 52 a of cylindrical body 52. Moreover, when the actuationmechanism is only partially operated, the spring-loaded pawl (not shown)operates to hold the actuation mechanism stationary and will continue tofunction to hold the actuation mechanism stationary until the actuationmechanism has been completely operated. In this way, the advancement ofligating clips 10 is controlled so that only a single ligating clip 10is expelled at a time.

In use, when pusher member 100 is advanced, the distal-most clip 10 ispushed from the distal end 52 a of cylindrical body 52. As illustratedin FIG. 7, clamping members 12, 14 of ligating clip 10 extend fromcylindrical body 52 but the diameter or width of ligating clip 10 in thefirst, or fully open, position is less than that of cylindrical body 52.Ligating clip 10 is maintained in the first, or fully open, position(FIG. 1) by the flat sides of inserts 54 a, 54 b until it is pushed fromand beyond the distal end 52 a of cylindrical body 52. Referring to FIG.8, when hub extension 20 passes distally beyond tube body 52 and engagesthe distal end of insert 54 b, the bias of torsion spring 28 (FIG. 2)rotates clamping member 14 approximately 180° in relation to clampingmember 12 until hub extension 20 abuts the flat side of distallyprotruding insert 54 a by which and whereat ligating clip 10 ismaintained in the second, or “ready” position. Alternately, but lesspreferably, insert 54 a may be positioned or configured to allowclamping member to rotate through greater or lesser arcs of rotation,e.g., 90°, 120°, 270°, etc., to provide any desirable orientation ofclamping members 12, 14 in the second, or ready, position. Because thecentral pivot axis-W of hub portions 16, 18 is offset from the centrallongitudinal axis-X of cylindrical body 52, in the ready position, theclamp opening, i.e., the distance between clamping surfaces 24 b and 26b, is uniquely greater than the diameter of cylindrical body 52. Thus,clamping members 12, 14 can be more easily positioned about tissue 90 tobe clamped. (See FIG. 10.)

Referring to FIG. 9, when pusher member 100 and, thus, ligating clip 10,is advanced further to the point at which hub extension 20 of hubportion 16 passes distally beyond the distal end of insert 54 a, thebias of torsion spring 28 effects rotation of clamp members 12, 14 tothe third, closed or clamped, position (FIGS. 9 and 11) in whichclamping surfaces 24 b, 26 b are in abutting relationship (FIG. 9) andtissue 90 is clamped therebetween (FIG. 11). After ligating clip 10 hasbeen clamped about tissue 90, the pusher member (not shown) can be leftin place as it has been pushing on the most proximal of a plurality ofaligned ligating clips 10 within cylindrical body 52, and, in that case,advanced further to dispense additional ligating clips 10 as and whendesired.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the configuration of thechannel 56 need not be that of a truncated cylinder. Otherconfigurations, which maintain ligating clip 10 in an open, or first,position during delivery of ligating clip 10 through channel 56 ofapplier 50, are envisioned. Although ligating clip 10 is shown as beingconstructed of multiple components, it is envisioned that ligating clip10 could be constructed from a single piece of spring wire or the like.Although no actuating mechanism has been disclosed to effect advancementof pusher member 100, any handle actuator assembly known in the surgicalarts for effecting advancement of a pusher member 100 including pistoltype actuators having trigger assemblies or in-line handle actuators maybe incorporated into applier 50 to effect advancement of pusher member100. Therefore, the above description should not be construed aslimiting, but merely as exemplifications of preferred embodiments. Thoseskilled in the art will envision other modifications within the scopeand spirit of the claims appended hereto.

1-24. (canceled)
 25. A method for occluding a vessel comprising thesteps of: making an incision in a patient; inserting an access deviceinto the incision; inserting a clip applier into the access device, theapplier having a distal end and at least one ligating clip, the at leastone ligating clip having a pair of distally extending ligation armsbiased to clampingly engage each other, the clip being in a firstposition of a plurality of positions; actuating an actuation mechanismlocated on or in the applier to cause the ligation arms of the ligatingclip to rotate to a second position of the plurality of positions, theligating arms in the second clip position being of a span greater than adiameter of the clip applier; positioning the ligating clip around thevessel; and actuating the actuation mechanism located on the applier tocause the ligating clip to biasedly rotate to a third position of theplurality of positions thereby clampingly engaging and occluding thevessel.
 26. The method of occluding a vessel of claim 25, wherein theligating clip in the second position has a larger outside diameter thanthe access device.
 27. The method of occluding a vessel of claim 26,wherein the applier includes a number of ligating clips.
 28. The methodof occluding a vessel of claim 25, wherein the access device is acannula.
 29. The method of occluding a vessel of claim 27, wherein theactuation mechanism is a trigger assembly.
 30. The method of occluding avessel of claim 25, wherein the applier further includes opposed firstand second inserts disposed along at least a portion of the inside ofthe elongate tube, at least one of the inserts extending beyond thedistal end of the applier and restraining the ligating clip in thesecond position.